Don McCanne responds to TNR’s Jonathan Cohn

Systems using private plans are more expensive, largely because of greater administrative complexity. Equity is more difficult to achieve in a multi-payer system. A system of universal risk pooling would have to be superimposed on the private plans, making us wonder why we would even want to keep them since they would no longer be providing their insurance function of transferring risk.

Today, affordability is a concern for everyone. Health care will never again be affordable for all of us unless we adopt structural changes within our health care delivery system. As stated in the TNR article, “We need to address the true major cost drivers: the profound administrative excesses, the lack of an adequate primary care infrastructure, the waste of non-beneficial high-tech excesses, and the lack of a rational system of health care pricing.” Realigning incentives to accomplish these goals would be a relatively straightforward task for a single payer government monopsony. In contrast, a market of competing private plans would not have the power of a monopsony and would have to rely on the government to achieve these same goals.

Those supporting the private plan/public option model need to be explicit in describing their model, beginning with simple concepts such as how they would prevent adverse selection in the public option. If we are going to have an equitable and effective health care financing system for all of us, then their task of radically transforming the private insurance industry so that it would actually work is far greater than our task of improving Medicare and then providing it to everyone. Let’s hear how they would do it.

My response is a lot shorter and far less learned: Why does Jonathan Cohn think he knows more about practical politics than John Conyers and the 90 cosponsors of HR 676? Seriously, that is a great deal of political muscle. What makes Cohn so sure they can't win? All of these representatives have won elections, most of them many, many elections. All of these representatives are veterans of many legislative battles. So why is Cohn a better judge of what is possible? Has Cohn ever won any election? Has he ever won any legislative battle? No? Then why would anyone listen to him?

We have a great champion in John Conyers, why not be guided by his wisdom?